Provider Demographics
NPI:1851054688
Name:MCCLAIN, LACEEY NICOLE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:LACEEY
Middle Name:NICOLE
Last Name:MCCLAIN
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:LACEEY
Other - Middle Name:NICOLE
Other - Last Name:RUBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2030 PORTAGE ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-3836
Mailing Address - Country:US
Mailing Address - Phone:269-491-9932
Mailing Address - Fax:
Practice Address - Street 1:2030 PORTAGE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-3836
Practice Address - Country:US
Practice Address - Phone:269-491-9932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511111761041C0700X
MI68011199371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical